Care Immediately Following ACL Reconstruction

Rehabilitation of an ACL reconstructed knee begins the day of surgery. It is very important that you follow the instructions from your surgeon and your physical therapist. This page serves as a reference only and does not replace your healthcare providers’ guidance and instructions. [Read our disclaimer]

Your surgeon’s instructions and rehabilitation protocols supersede the content of this page.

Brace

The knee brace given to you immediately after surgery must be worn in locked extension (straight leg) while walking and sleeping. You may take the brace off when doing exercises and/or the continuous passive motion (CPM) machine. Brace hinges must be at the level of the knee cap.

You may loosen or tighten the brace straps as necessary. It is important to keep the top straps tight in order to prevent the brace from moving up and down on the leg. You will need to wear the brace for about 4-6 weeks. Your surgeon or physical therapist will unlock the hinges, as well as instruct you to take it off when appropriate. While putting your brace on, it is easier to keep your leg straight and your thigh muscle tight.

Elevation

When you are not walking, your leg should be straight with a pillow or rolled towel under your foot or ankle (not behind your knee).

Try to elevate knee as much as possible to reduce swelling. This means that the level of the knee must be above the heart.

Never Put Anything Under Your Knee!

It may be tempting to place a pillow or towel under your knee for comfort. However, doing so may hinder the process of regaining and maintaining full knee extension (straightening). Having full extension is one of the top priorities in the early post-operative phase, as it contributes to normal walking pattern and restoring quad muscle activation.

Hence, you must NEVER put anything under your knee when you are resting, sleeping, or propping your leg up. The pillow must go under the heel.

Ice

An ice machine may be prescribed and delivered to you. This will help decrease swelling and pain after your surgery. Use the ice machine as much as possible when you get home at intervals of 20 minutes on and off. You should keep the ice machine for about two weeks. Do not use the ice machine while you are sleeping.

If you did not receive an ice machine, you should use ice packs over your knee at intervals of 20 minutes on and off throughout the day. Do not place ice directly on the skin, as it may cause a skin burn. Use a thin shirt or towel between your skin and the ice.

CPM (Continuous Passive Motion) Machine

A continuous passive motion (CPM) machine may be prescribed and delivered to you – you should use this machine for a minimum of 4 hours a day, for 2 weeks post-operatively. Begin at 0-40 degrees and then progress 5-10 degrees of flexion daily as tolerated with the end goal of 95 degrees. You will experience some discomfort while trying to increase your flexion range of motion.

Don’t forget to take your brace off while using it!

Crutches

How your crutches should fit:

  1. Stand tall and place the crutches under your arms.
  2. Relax your arms and let them hang down over the crutches.
  3. There should be a two finger-width space between your armpit and the top of the crutch.
  4. The hand grips should be at the level of your wrist.
  5. Your elbows should have a comfortable bend of about 20-30 degrees when the hands are holding the grips.

Use your crutches in accordance to your weight bearing status after surgery:

Weight bearing as tolerated (WBAT)

Weight bearing as tolerated (WBAT)

Sitting to standing

  1. Hold both crutch handles in one hand on the opposite side of the involved leg.
  2. Scoot your buttocks closer to the edge of the chair or surface.
  3. Place the hand on the same side of the involved leg on the arm rest or edge of the seat.
  4. Lean forward, and using both arms and the uninvolved leg, move from sitting to standing.
    • You can place the whole foot of the involved leg on the floor, putting as much weight on it as you can tolerate
  5. Once standing, move one crutch to the other side.

Standing to sitting

  1. Move close to the seat so that the back of your leg is touching the chair.
  2. Move both crutches to the side opposite of the involved leg, placing both handles in one hand.
  3. Reach backward with your free hand, placing it on the armrest or the surface in which you will be sitting.
  4. Slowly lower yourself to the seat using both arms, your uninvolved leg, and as much weight as you can tolerate on the involved leg.

Walking, bilateral crutches, step-to pattern

  1. Move both crutches forward.
  2. Take a step with the involved leg so that it is even with the crutches.
    • As much weight as you can tolerate
  3. Then, follow with the uninvolved leg.

Walking, bilateral crutches, reciprocal pattern (ONLY for WBAT)

  1. Take a step while moving the opposite side’s crutch (i.e, right crutch and left foot together, and left crutch and right foot together).

Walking, single crutch, step-to pattern (ONLY for WBAT)

  1. Use the crutch on the opposite side of the involved leg.
  2. Move crutch forward.
  3. Take a step with the involved leg so that it is even with the crutch.
  4. Then, follow with the uninvolved leg.

Walking, single crutch, reciprocal gait (ONLY for WBAT)

  1. Use the crutch on the opposite side of the involved leg.
  2. Move the crutch together with each step the involved leg takes.

Going up stairs, bilateral crutches

  1. Place both crutches together under one arm and hold on to the handrail with the opposite hand.
  2. Step with the uninvolved leg first, followed by the involved leg.
  3. Bring the crutches up to the step.

Going up stairs, single crutch (ONLY for WBAT)

  1. Use the crutch on the opposite side of the involved leg.
  2. Step with the uninvolved leg first, followed by the involved leg.
  3. Bring the crutch up to the step.

Going down stairs, bilateral crutches

  1. Place both crutches together under one arm and hold on to the handrail with the opposite hand.
  2. Place the crutches on the step below you.
  3. Step down with the involved leg first, followed by the uninvolved leg.

Going down stairs, single crutch (ONLY for WBAT)

  1. Use the crutch on the opposite side of the involved leg.
  2. Place the crutch on the step below you.
  3. Step down with the involved leg first, followed by the uninvolved leg.
Partial weight bearing (PWB)

Partial weight bearing (PWB)

Sitting to standing

  1. Hold both crutch handles in one hand on the opposite side of the involved leg.
  2. Scoot your buttocks closer to the edge of the chair or surface.
  3. Place the hand on the same side of the involved leg on the arm rest or edge of the seat.
  4. Lean forward, and using both arms and the uninvolved leg, move from sitting to standing.
    • You can place the ball of your foot of the involved leg on the floor for stability as you transition to standing
  5. Once standing, move one crutch to the other side.

Standing to sitting

  1. Move close to the seat so that the back of your leg is touching the chair.
  2. Move both crutches to the side opposite of the involved leg, placing both handles in one hand.
  3. Reach backward with your free hand, placing it on the armrest or the surface in which you will be sitting.
  4. Slowly lower yourself to the seat using both arms, your uninvolved leg, and the ball of the foot of the involved leg for stability.

Walking, bilateral crutches, step-to pattern

  1. Move both crutches forward.
  2. Take a step with the involved leg so that it is even with the crutches.
    • Place the ball of the foot on the floor for stability
  3. Then, follow with the uninvolved leg.

Going up stairs, bilateral crutches

  1. Place both crutches together under one arm and hold on to the handrail with the opposite hand.
  2. Step with the uninvolved leg first, followed by the involved leg.
  3. Bring the crutches up to the step.

Going down stairs, bilateral crutches

  1. Place both crutches together under one arm and hold on to the handrail with the opposite hand.
  2. Place the crutches on the step below you.
  3. Step down with the involved leg first, followed by the uninvolved leg.
Non-weight bearing (NWB)

Non-weight bearing (NWB)

Sitting to standing

  1. Hold both crutch handles in one hand on the opposite side of the involved leg.
  2. Scoot your buttocks closer to the edge of the chair or surface.
  3. Place the hand on the same side of the involved leg on the arm rest or edge of the seat.
  4. Lean forward, and using both arms and the uninvolved leg, move from sitting to standing.
    • Keep the involved leg off the floor
  5. Once standing, move one crutch to the other side.

Standing to sitting

  1. Move close to the seat so that the back of your leg is touching the chair.
  2. Move both crutches to the side opposite of the involved leg, placing both handles in one hand.
  3. Reach backward with your free hand, placing it on the armrest or the surface in which you will be sitting.
  4. Slowly lower yourself to the seat using both arms and your uninvolved leg, keeping the involved leg off the floor.

Walking

  1. Move both crutches forward.
  2. Push down on the handgrips and swing your body forward to land on your noninvolved leg between the two crutches.

Going up stairs

  1. Place both crutches together under one arm and hold on to the handrail with the opposite hand.
  2. Hop onto the step with the uninvolved leg, keeping the involved leg from touching the ground.
  3. Bring the crutches up to the step.

Going down stairs

  1. Place both crutches together under one arm and hold on to the handrail with the opposite hand.
  2. Keep the involved leg in front of your body and off the ground.
  3. Place the crutches on the step below you.
  4. Hop down to the step below, landing on the uninvolved leg.

Going up stairs, bumping

  1. Turn and face away from stairs
  2. Hold on to the handrail with one hand and reach back with your opposite hand
  3. Using your arms and your uninvolved leg, slowly lower your buttocks to a step
  4. Place your hands on the step above and push yourself up to that step

Going down stairs, bumping

  1. Use your arms to lower yourself down to the next step
  2. When you get to the bottom of the stairwell, use the handrails to pull yourself to standing (or push off the step with one hand)

Going up stairs, assisted bumping

  1. Turn and face away from stairs
  2. Hold on to the handrail with one hand and reach back with your opposite hand
  3. Using your arms and your uninvolved leg, slowly lower your buttocks to a step
  4. Place your hands on the step above and push yourself up to that step with your involved leg supported by someone

Going down stairs, assisted bumping

  1. Use your arms to lower yourself down to the next step with your involved leg supported by someone
  2. When you get to the bottom of the stairwell, use the handrails to pull yourself to standing (or push off the step with one hand)

Dressing

Keep your surgical dressing clean and dry. Do not remove your dressing until your first post-operative visit, or until instructed by your surgeon or physical therapist.

Showering

You may shower 48 hours after surgery, however you must place a plastic bag over your knee and dressing. You may remove the brace but please use caution!! Be careful not to slip, twist, or fall. A stool placed in the shower so you can sit is a great idea. Do not submerge your wound under water for 4 weeks after surgery, or when your surgeon clears you to do so.

Physical Therapy

Depending on your procedure, your surgeon may give you a prescription to start physical therapy within a few days after surgery, or delay starting for a certain duration. If you have not started PT by your first post-operative visit, be sure to ask about it.

Physical therapy is vital to your recovery, especially during the early post-operative phase. It will help you manage pain and swelling, improve motion and mobility, and regain muscle strength. Your physical therapist will serve as your guide to ensure your recovery is smooth and address any potential issues that arise.

Please follow the instructions and home exercise program that your physical therapist provide to maximize your recovery!

Common Concerns

Depending on the procedure you had, you may experience numbness around the incision site and on the outside of the knee. This is a result of the disruption of a superficial nerve during the operative procedure and is a common side effect. Over time, the area of numbness may decrease.

A sudden rush or feeling of fullness with pain in the knee after standing is common after surgery. Icing and elevating frequently can help combat it. Using an ACE bandage to provide compression throughout the day can decrease this discomfort.

You may also experience bruising and/or swelling of the shin and ankle after surgery. This is caused by bleeding into the area just below the skin. Ice, elevate, and ACE bandage compression may help improve them.

Exercises

Quad Set

While sitting on a flat surface with your legs straight, tighten your thigh muscle while pushing the back of your knee into the bed. Repeat 20 times, hold each for 10 secs.  This exercise will help work your quads and get your leg straight.

Gastroc Stretch

Perform 10 repetitions, hold each for 30 secs.

Supine Low-Load Long-Duration

Sit up or lie on your back with both legs straight and your ankle propped up on a pillow or rolled towel. Make sure there is a gap between the back of your knee and the surface you are on. Place a 5 lbs weight above your knee and hold that position for 5 to 30 mins, as tolerated. Add another weight below your knee to increase the stretch intensity. Try as much as you can to relax.

This exercise will help straighten your knee. Alternatively, you can hang the straps of a backpack or handles of a tote bag above and below your knee with weights or everyday objects placed in them.

Prone Hang

Lie on your stomach with both legs straight. Slowly push yourself toward the foot on your bed until your legs are hanging over the edge (your knee caps should be off the edge). Allow your legs to hang there, holding that position for 5 to 30 mins, as tolerated.

This exercise will help straighten your knee.

Straight-Leg Raise

Lie on your back with your knee straight. Bend your other knee so that you can put your foot flat on the bed. Contract your quad tightly before you raise your leg (see quad set). Slowly raise your involved knee, keeping the knee locked. Slowly lower the leg back to the starting position.

If you are unable to raise your leg without your knee bending, perform these with your brace locked in full extension.

Perform 3 sets of 15 repetitions each side.

Heel Slide Knee Flexion AAROM

Lie on your back with your knee brace removed. Slowly bend your knee, sliding your foot along the surface of the floor, using a strap around the forefoot to assist. Once you have bent your knee as much as possible, slide your foot back down until your knee is straight.

Tip: The foot slides more easily with the shoe off and wearing a sock or using a towel.

Perform 20 repetitions, hold each for 10 secs.

Wall Slide Knee Flexion AAROM

Wall Slide Knee Flexion AAROM

While laying on your back and foot starting high up on the wall, use your non-surgical leg to help control the descend and bending of the knee as your foot slides down the wall. When you gain more range of motion, you can start using the non-surgical leg to help bend it more. As your quad gets stronger, return to the starting position without assistance from the non-surgical leg. 

Tip: The foot slides more easily with the shoe off and wearing a sock or using a towel.

Perform 20 repetitions, hold each for 10 secs.

Seated Knee Flexion AAROM

Seated Knee Flexion AAROM

While in a seated position, use your non-surgical leg to help control the descend and bending of the knee. When you gain more range of motion, you can start using the non-surgical leg to help bend it more. As your quad gets stronger, return to the starting position without assistance from the non-surgical leg.  

Perform 20 repetitions, hold each for 10 secs.

Seated Hip Flexion

While in a seated position, keep your torso upright while lifting your knee up.  

Perform 3 sets of 15 repetitions each side.

Sidelying Hip Abduction

Lie on your uninjured side and bend your noninvolved (bottom) knee. With your surgically repaired knee held straight, slowly raise your leg toward the ceiling, then slowly lower it again. This exercise can be performed with or without the knee brace.

Perform 3 sets of 15 repetitions each side.

Sidelying Hip Adduction

Lie on your operated side and bend your noninvolved (top) knee. With your operated leg held straight, slowly raise your leg toward the ceiling, then slowly lower it again. This exercise can be performed with or without the knee brace.

Perform 3 sets of 15 repetitions each side.

Prone Hip Extension

Perform 3 sets of 15 repetitions each side.

You should call your surgeon’s office immediately if:

  1. You experience oozing or redness of the wound, fevers (>101 degrees F), or chills.
  2. You have significant pain and tenderness in your calf, back of knee, thigh, or groin.
  3. You have red or discolored skin (not bruising).
  4. You have distended veins in your leg.

Call 911 if:

  1. You experience difficulty breathing or heaviness in the chest.
  2. You are coughing or spitting up blood.
  3. You feel that you need emergency care.